Management of neoplastic polyps in inflammatory bowel disease

Dysplasia-associated lesions or masses (DALMs) are a heterogeneous population of lesions with different endoscopic and morphologic features. Non-adenoma-like DALMs should be removed via colectomy. Adenoma-like DALMs that occur outside areas of colitis can be treated like sporadic adenomas and removed by polypectomy. Recent data suggest that adenoma-like DALMs located within areas of colitis should be removed by polypectomy with complete excision and multiple biopsies of the site. As long as there is no flat dysplasia or adenocarcinoma elsewhere in the colon, a colectomy is not required. However, this group of patients requires increased colonoscopic surveillance.